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NGR 6244C Health Management of Adults and Older Adults Nurse Practitioner Adult Health Case Study FNP Pulmonology Case Study

Mason is a 55 y.o. homeless man who is seen today for the first time. He is a smoker, states he has frequent colds, and a routine morning cough. He used to be short of breath just walking up hills, but now states that he has difficulty breathing with everyday activities and is having trouble on the streets trying to find food because he cannot walk very far. He just wants medicine to help him survive on the streets. On examination, you find him using his accessory muscles to breath. His VS are: 99°, 100 bpm, 28 R, BP 140/90. Breath sounds are distant with end expiratory wheezes heard on expiration. He has a slight barrel chest and neck vein distention.

Critical Thinking Questions


  1. What should your initial diagnostic evaluation include
  2. Should you include an ECG?


  1. What are your differential diagnoses?

  2. What is your diagnosis for Mason?


  1. What is your initial management?

  2. What other teaching should be done?

  3. What resources are available in your community for a homeless man with COPD?

  4. What other preventive health services should be offered to Mason?

  5. What billing codes would you use?

  6. What level office visit would you bill? (If Mason were a regular Medicare patient, not homeless).  


Please give a rational for your decision

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